Pancreatology最新文献

{"title":"Normal-fat versus fat-restricted diets in patients with acute pancreatitis: A randomized controlled study (NouRish-AP study).","authors":"Nutchakorn Kittisuphat, Narisorn Lakananurak, Pradermchai Kongkam","doi":"10.1016/j.pan.2025.08.011","DOIUrl":"https://doi.org/10.1016/j.pan.2025.08.011","url":null,"abstract":"<p><strong>Background/objectives: </strong>International guidelines recommend a low-fat diet (LFD) in patients with acute pancreatitis (AP); however, no randomized controlled trials have compared LFD with a normal fat diet (NFD). The necessity of LFD remains uncertain, with concerns about its palatability and lower energy density potentially leading to reduced intake and quality of life (QoL). This study evaluates the efficacy and safety of NFD versus LFD in patients with mild to moderately severe non-hypertriglyceridemic AP.</p><p><strong>Methods: </strong>This randomized controlled study enrolled patients from July 2022 to April 2023. Participants were randomly assigned to either NFD (30 % of total calories from fat) or LFD (15 % of total calories from fat). The primary outcome was daily energy intake. Secondary outcomes included QoL, complications, length of stay (LOS), and 90-day readmission.</p><p><strong>Results: </strong>Sixty-five patients were enrolled (33 NFD, 32 LFD). The NFD group had significantly higher energy intake during the first two intervention days (Day 1: 18.7 vs. 12 kcal/kg/day, p = 0.007; Day 2: 18.6 vs. 12.7 kcal/kg/day, p = 0.005) and in the malnourished subgroup (23.2 vs. 15.6 kcal/kg/day, p = 0.024). However, overall energy intake was not significantly different (18.9 vs. 16.5 kcal/kg/day, p = 0.087). NFD resulted in significantly higher QoL scores in the physical (53.9 vs. 39.4, p = 0.019) and mental domains (55.9 vs. 40.7, p = 0.004). No significant differences were found in abdominal pain, triglyceride increment, infections, LOS, or 90-day readmission.</p><p><strong>Conclusions: </strong>NFD was associated with higher calorie intake during the first two days of oral feeding in patients with mild and moderately severe AP, along with better QoL and no increase in adverse events. Routine LFD prescription may not be necessary, making NFD a viable option for non-hypertriglyceridemic AP patients.</p><p><strong>Clinical trial registration: </strong>The trial was registered, and the protocol is available online at Thaiclinicaltrials.org (Identifier: TCTR20230926008).</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 3c diabetes associated with chronic pancreatitis: A narrative review.","authors":"Abdul Rasheed, Sheethal Galande, Shagufta Farheen, Sasikala Mitnala, D Nageshwar Reddy, Rupjyoti Talukdar","doi":"10.1016/j.pan.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.pan.2025.08.005","url":null,"abstract":"<p><p>Diabetes associated with pancreatic diseases is termed Type 3c DM (T3cDM). This is a unique entity that shares characteristics of both Type 1 and Type 2 diabetes and has its own characteristics. The prevalence of T3cDM in the western population is less than 10 % of all diabetic patients. The most common cause of T3cDM is chronic pancreatitis (CP) followed by causes such as pancreatic ductal adenocarcinoma, pancreatic agenesis, cystic fibrosis, hemochromatosis, pancreatic resections, and acute necrotizing pancreatitis. In this review, we discuss T3cDM associated with CP. The broad mechanisms related to the development of T3cDM includes insulin deficiency, hepatic insulin resistance, peripheral insulin resistance, and reduced incretin effect. Although insulin deficiency (resulting from secretory defect, islet loss, and gut microbial dysbiosis) and hepatic insulin resistance have been understood, the role of peripheral insulin resistance and impaired incretin effect warrants further validation. The diagnosis of T3cDM in general can be done using the ADA criteria. However, the pancreatic polypeptide response to a mixed meal can differentiate T3cDM from T1DM and T2DM. Among the non-specific treatment, besides abstinence from alcohol and smoking, pancreatic enzyme replacement therapy (PERT) could aid in glycemic control. Among the specific treatment, in patients with mild uncomplicated T3cDM, metformin is the first choice. Insulin sensitizers and secretagogues, and incretin-based therapies are not currently recommended. For severe complicated T3cDM, a basal-bolus approach with insulin therapy is advocated. Promising future approaches includes metabolome-based prediction of progression of prediabetes to T3cDM, and treatment with PP and fecal microbial manipulation.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A porcine model of acute necrotizing pancreatitis.","authors":"Joerg M Steiner, Hana Algül, Dietrich A Ruess, Ihsan Ekin Demir, Rickmer Braren, Sabine Schwamberger, Marina Lesina, Judith Reiser, Julia Werner, Tanja Groll, Thomas Metzler, Katja Steiger","doi":"10.1016/j.pan.2025.07.415","DOIUrl":"https://doi.org/10.1016/j.pan.2025.07.415","url":null,"abstract":"<p><strong>Background/objectives: </strong>Acute necrotizing pancreatitis is a common disease in humans and leads to significant and world-wide morbidity and mortality. Exploration of new pharmaceutical agents for the treatment of this disease frequently rests on rodent models that may not be relevant for spontaneous human disease and also preclude collecting multiple blood samples. Goal of this project was to establish an experimental model for acute necrotizing pancreatitis in pigs that mirrors the development of systemic complications of acute pancreatitis in humans as a prelude to clinical trials in humans.</p><p><strong>Methods: </strong>The accessory pancreatic duct was surgically isolated in domestic pigs and 8 μmol/kg glycodeoxycholic acid were slowly injected into the duct, followed by ligation and cutting the duct. Pigs were repeatedly evaluated clinically and multiple blood samples were collected before the pigs were sacrificed and their organs histopathologically assessed after 1, 5, or 7 days.</p><p><strong>Results: </strong>All pigs showed clinical and clinical pathological evidence of pancreatitis after induction of pancreatitis. Pigs showed histopathological evidence of acute necrotizing pancreatitis one day after induction of pancreatitis. At 7 days after induction of pancreatitis, dramatic regeneration could be observed in the pancreas. At 5 days after induction of pancreatitis, evidence of necrotizing pancreatitis was present with less evidence of regeneration.</p><p><strong>Conclusions: </strong>The porcine model for acute necrotizing pancreatitis described here shows many parallels to spontaneous human disease and its systemic complications and may thus serve as a good model to assess the efficacy of novel pharmaceutical agents for the treatment of acute pancreatitis in humans.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body roundness index is better than body mass index in identifying intrapancreatic fat deposition.","authors":"Yiping Zhang, Dingzhe Zhang, Yu Wang, Hao Zhou, Xifa Gao, Rui Yu, Jianhua Wang, Xiao Chen","doi":"10.1016/j.pan.2025.07.414","DOIUrl":"https://doi.org/10.1016/j.pan.2025.07.414","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on “Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort”","authors":"Iman Zahir ,&nbsp;Maryam Asghar Jamal","doi":"10.1016/j.pan.2025.07.001","DOIUrl":"10.1016/j.pan.2025.07.001","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Page 766"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of acute pancreatitis in patients treated with GLP-1 receptor agonists for weight management","authors":"Robert Postlethwaite ,&nbsp;Amin M. Amin ,&nbsp;Rand Alsawas ,&nbsp;Jaime P. Almandoz ,&nbsp;Tarek Sawas","doi":"10.1016/j.pan.2025.06.018","DOIUrl":"10.1016/j.pan.2025.06.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely prescribed for treating obesity and Type 2 Diabetes (T2D). There have been concerns that GLP-1RA is associated with acute pancreatitis (AP), although the data are controversial. We aimed to identify factors that impact the risk of AP after initiation of GLP-1RA treatment for obesity.</div></div><div><h3>Methods</h3><div>We performed a retrospective case-control study including adults patients initiated on a GLP-1RA for obesity management to determine risk factors associated with AP in obese patients taking GLP-1RA. We identified patients initiated on GLP-1RA. A multivariable logistic regression model was used to identify predictors of AP with GLP-1RA use.</div></div><div><h3>Results</h3><div>There were 2245 patients, of which 49 (2.2 %) developed AP after starting a GLP-1RA. A history of gallstone disease (adjusted odds ratio (aOR), 2.9 [95 % CI, 1.6 to 5.3]), history of AP (aOR 4.8 [CI, 1.8 to 13.2]), CAD/PVD (aOR 2 [CI, 1.01 to 3.9]) and tobacco use (aOR 2.4 [CI, 1.2 to 4.7]) were associated with a higher risk of AP with GLP-1RA use. Compared to a BMI ≤30 kg/m², BMI categories 36–40 and &gt; 40 were associated with a lower risk of AP with GLP-1RA therapy, (aOR 0.2 [CI, 0.06 to 0.6]) and (aOR 0.25 [CI, 0.09 to 0.68]), respectively.</div></div><div><h3>Conclusion</h3><div>A history of gallstone disease, history of AP, CAD/PVD, and tobacco use were associated with AP after initiation of GLP-1RA for obesity treatment. A higher BMI appears to be protective against AP. Recognizing factors associated AP after GLP-1RA initiation can inform clinicians on risk stratification.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 609-613"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Comments on “Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort”","authors":"A.A. van Zweeden ,&nbsp;L.G.M. van der Geest ,&nbsp;J.W. Wilmink","doi":"10.1016/j.pan.2025.07.012","DOIUrl":"10.1016/j.pan.2025.07.012","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 767-768"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of paracetamol and tramadol for pain management in acute pancreatitis: A double-blinded randomized study","authors":"Hemanta Kumar Nayak ,&nbsp;Shubham Gupta ,&nbsp;Abhijeet Rai ,&nbsp;Subhabrata Biswal ,&nbsp;Mansi Chaudhary ,&nbsp;Kamlesh Ahari ,&nbsp;Arpana Pandey ,&nbsp;Saswati Kar ,&nbsp;Sagarika Panda ,&nbsp;Ranjan Kumar Patel ,&nbsp;Manas Kumar Panigrahi ,&nbsp;Subash Chandra Samal","doi":"10.1016/j.pan.2025.07.003","DOIUrl":"10.1016/j.pan.2025.07.003","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 752-754"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards automating risk stratification of intraductal papillary mucinous Neoplasms: Artificial intelligence advances beyond human expertise with confocal laser endomicroscopy","authors":"Somashekar G. Krishna ,&nbsp;Ahmed Abdelbaki ,&nbsp;Ziwei Li ,&nbsp;Stacey Culp ,&nbsp;Xinqi Xiong ,&nbsp;Bertrand Napoleon ,&nbsp;Shaffer Mok ,&nbsp;Helga Bertani ,&nbsp;Yunlu Feng ,&nbsp;Pradermchai Kongkam ,&nbsp;Anjuli K. Luthra ,&nbsp;Jorge D. Machicado ,&nbsp;Samer El-Dika ,&nbsp;Sarah Leblanc ,&nbsp;Damien Meng Yew Tan ,&nbsp;Jordan Burlen ,&nbsp;Margaret G. Keane ,&nbsp;Tara Keihanian ,&nbsp;Antonio Mendoza Ladd ,&nbsp;Thiruvengadam Muniraj ,&nbsp;Wei-Lun Chao","doi":"10.1016/j.pan.2025.05.011","DOIUrl":"10.1016/j.pan.2025.05.011","url":null,"abstract":"<div><h3>Background and aims</h3><div><span><span>Endoscopic Ultrasound (EUS)-guided needle-based </span>confocal laser endomicroscopy<span> (nCLE) enables real-time microscopic visualization of pancreatic cyst epithelium and can identify high-grade dysplasia/invasive adenocarcinoma (HGD/IC) in branch-duct (BD) </span></span>intraductal papillary mucinous neoplasms<span> (IPMNs). We aimed to compare the performance of experts (humans) with artificial intelligence (AI) in stratifying dysplasia in BD-IPMNs.</span></div></div><div><h3>Methods</h3><div><span>This post-hoc analysis involved BD-IPMNs with definitive diagnoses from prospective EUS-nCLE studies (2015–2023) enrolled at a single center. Dysplasia grade was reviewed by two pathologists. Blinded EUS-nCLE experts reviewed unedited nCLE videos to classify dysplasia without and with revised Fukuoka criteria (revised-FC). The AI model, </span><em>nCLE-AI</em>, was similarly analyzed. Diagnostic parameters and AUC were compared to evaluate human and <em>nCLE-AI</em> performance.</div></div><div><h3>Results</h3><div>Among 60 BD-IPMNs (mean size = 3.43 ± 1.00 cm), 23 (38.3 %) had HGD/IC. To detect HGD/IC using nCLE, interobserver agreement (IOA) among 16 nCLE experts was ‘fair’ (κ = 0.29, 95 % CI: 0.27–0.32), with a sensitivity of 58 %, specificity of 59 %, and AUC of 0.59 (95 % CI 0.55–0.62). Incorporating revised-FC improved the sensitivity to 72 % and AUC to 0.64 (95 % CI 0.61–0.68; p &lt; 0.001), with similar IOA (κ = 0.36 ‘fair’, 95 % CI: 0.33–0.38) and specificity (57 %).</div><div>Comparatively, <em>nCLE-AI</em> achieved 87 % sensitivity, 54 % specificity, and an AUC of 0.70 (0.57–0.84). When combined with revised-FC, <em>nCLE-AI</em> reached 78 % sensitivity, 78 % specificity, and an AUC of 0.85 (95 % CI: 0.74–0.96, p = 0.02), significantly higher than humans with revised-FC (p &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Human dysplasia classification of BD-IPMNs using nCLE showed modest IOA and accuracy. In contrast, <em>nCLE-AI</em> classifications combined with clinical criteria offer superior accuracy for detecting HGD/IC while eliminating interobserver variability.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 658-666"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should gastrointestinal bleeding and impaired mental status be considered organ failure in patients with acute pancreatitis?","authors":"Lucía Guilabert ,&nbsp;Karina Cárdenas-Jaén ,&nbsp;Alicia Vaillo-Rocamora ,&nbsp;Laura Sempere ,&nbsp;Enrique de-Madaria","doi":"10.1016/j.pan.2025.06.015","DOIUrl":"10.1016/j.pan.2025.06.015","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 755-757"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}